SYSTEMIC INFECTION RELATED TO ENDOCARDITIS ON PACEMAKER LEADS - CLINICAL PRESENTATION AND MANAGEMENT

Background Endocarditis related to pacemaker (PM)-lead infection is a rare but serious complication of permanent transvenous pacing. To dete rmine in which situations the diagnosis should be evoked and to determ ine optimal management, we reviewed our experience with endocarditis r elated to PM-lead infection. Methods and Results Fifty-two patients we re admitted for endocarditis related to PM-lead infection. The present ation was acute in 14 patients, with onset of symptoms in the first 6 weeks after the last procedure on the implant site, and chronic in 38 patients. Fever occurred in 86.5%. Clinical and/or radiological eviden ces of pulmonary involvement were observed in 38.4%. Pulmonary scintig raphy disclosed pulmonary infarcts in 31.2%. Local complications were found in 51.9%. Elevated C-reactive protein was found in 96.2%. A germ was isolated in 88.4% of patients and was a Staphylococcus in 93.5%. Transthoracic echocardiography demonstrated vegetations in only 23% of patients, whereas transesophageal echocardiography disclosed abnormal appearances on the PM lead in 94%. We systematically tried to ablate all the material. Two techniques were used: percutaneous ablation or s urgical removal during extracorporeal circulation. All patients were t reated with antibiotics after removal of the infected material. Two pa tients died before lead removal and 2 after surgical removal; the pred ischarge mortality was 7.6%, and the overall mortality was 26.9% after a follow-up of 20.1+/-13 months. Conclusions The diagnosis of endocar ditis related to PM-lead infection should be suspected in the presence of fever, complications, or pulmonary lesions after PM insertion. Tra nsesophageal echocardiography should be performed to look for vegetati ons. Staphylococci are involved in the majority of these infections. T he endocardial system must be entirely removed and appropriate antibio tic therapy pursued for 6 weeks.